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Mesh and fixation in Laparoscopic inguinal hernia repair

Mesh and fixation in Laparoscopic inguinal hernia repair. Mr Duncan Light Consultant upper GI surgeon Northumbria NHS Trust www.nugit.nhs.uk. Mesh classification. Synthetic Polypropylene PVDF Polyester Biosynthetic PGA P4HB Biological Porcine Bovine Fetal Cadaver. Structure/weave

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Mesh and fixation in Laparoscopic inguinal hernia repair

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  1. Mesh and fixation in Laparoscopic inguinal hernia repair Mr Duncan Light Consultant upper GI surgeon Northumbria NHS Trust www.nugit.nhs.uk

  2. Mesh classification • Synthetic • Polypropylene • PVDF • Polyester • Biosynthetic • PGA • P4HB • Biological • Porcine • Bovine • Fetal • Cadaver • Structure/weave • Pore size • > 1mm • Weight • 80gm2 • Mechanical properties • Tensile strength • Stiffness • Elasticity • Complicance

  3. Mesh immune response • Foreign body response • Fibroblasts and immune response • Chronic process • Granuloma formation • Scar plate • Implicated in mesh shrinkage • Potential reduction with large pore size (>1mm)

  4. RECURRENCE CHRONIC PAIN WOUND COMPLICATIONS QUALITY -------------------- VALUE = COST READMISSIONS HOSPITAL VISITS LOS RESOURCES

  5. Fixation • Tacks • Absorbable • Non-absorbable • Staples? • Glue • Fibrin • Cyanoacylate • Self-fixating mesh

  6. Fixation

  7. RECURRENCE CHRONIC PAIN WOUND COMPLICATIONS QUALITY -------------------- VALUE = COST READMISSIONS HOSPITAL VISITS LOS RESOURCES

  8. References • International guidelines for groin hernia management. Herniasurge group. Hernia 2018. 22 (1): 1-65 • Past, Present and Future of Surgical Meshes: A Review. Baylon, Karen & Rodríguez-Camarillo, Perla & Elías-Zúñiga, Alex & Díaz-Elizondo, José & Gilkerson, Robert & Lozano, Karen. (2017). Membranes. 7. 47

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